Routine inspection·March 16, 2023

On 03/16/2023 at 12:15pm, Licensing Program Analyst (LPA) Arielle Pascua arrived to this facility unannounced to conduct an Annual Visit. LPA Pascua was greeted by staff members, Tyrone Cooper and Jennifer Richards and explained the purpose of the visit. LPA asked at this time for the staff members to call the Facility Designated Administrator (FDA) to inform her that CCL was present at this time. Shortly after, FDA Placintar arrived at the facility. Current census was 4. This facility is currently licensed to hold 6 residents who may be deemed non-ambulatory. This facility has a hospice waiver for 2 and has a dementia plan on file. Current census was 4. Administrator holds an active and current certificate #6000942740 and expires on 06/23/2024. LPA Pascua reviewed 4 resident files. 4 out of 4 resident files were up to date. LPA reviewed 2 staff files. 2 out of 2 resident files files were up to date. LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with the staff member, the LPA observed, reviewed, and compared resident medication and electronic medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour with FDA Placintar was conducted. Fire extinguisher located in the hallway was serviced by Jorgensen Co on 02/27/2023. Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. LPA observed a sufficient amount of 2 day perishable and 7 day non-perishable food supply to meet the residents needs. Knives were observed to be locked and made inaccessible to the residents in care. A tour of the garage was conducted. Additional storage for supplies were identified. Additional food supply was identified. A tour of the laundry room was conducted, laundry detergent, bleach and all other cleaning supplies were made inaccessible to the residents at this time. A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A tour of two staff bedrooms were also conducted. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. The exterior of the physical plant was in good repair with no hazards present. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL. -LIC 308 -LIC 400 -LIC 500 -LIC 610 No deficiencies were observed or cited during this annual visit. A copy of this report was given to Facility Designated Administrator. Exit interview was conducted